Your article on setting up a PGD for yellow fever(Guidelines in Practice Vol 5, April, pp. 49-56) has me worried. Has the legislation been changed to allow a PGD to be used in a non-NHS setting? If it hasn°t, this PGD could not be used for the majority of vaccinations because yellow fever vaccines for travel are not a charge on the NHS.
Kay Scott, Prescribing Adviser, Medway PCT
I have been enjoying following Jane Chiodini°s excellent series but I think she may have slipped up. My reading of the Health Service Circular for PGDs is that - at present - PGDs can only be used within the NHS.1
Yellow fever vaccine is never given within the NHS as it is always a private transaction, so you cannot produce a PGD for administration of yellow fever vaccine. Therefore I think the article is misleading.
I would be grateful for Jane°s comments.
Andrew Martin, Prescribing Adviser, Bury PCT
- NHS Executive (2000). Patient Group Directions (England Only). HSC 2000/026. Leeds: NHSE.
Jane Chiodini replies:
This question is interesting and appears to identify a grey area. The guidance (HSC 2000/026) states:
¿The legislation applies to the NHS, including private and voluntary sector activity funded by the NHS. Therefore it covers treatment provided by NHS Trusts, Primary Care Trusts, Health Authorities (including SHAs), GP or dentist practices, walk in centres and NHS funded family planning clinics. It does not otherwise apply to the private and voluntary sectors (further legislation is proposed in due course).î
While yellow fever vaccine is provided privately, i.e. it is not available under the NHS, it is given in an NHS setting, for example a GP surgery, administered by the practice nurse.
Approval for a centre to administer the yellow fever vaccine must be sought from the Department of Health which authorises the centre to perform vaccinations privately.
In most cases in general practice doctors do not prescribe the yellow fever vaccine before the nurse administers it (however, some were doing this recently when there were no licensed products available).
Patient group directions (PGDs) are not yet a legal requirement for the sale, supply and administration of medicines by health professionals in the private, charitable and voluntary healthcare sectors and in certain Crown establishments. However, a consultation letter has been published and the outcome is expected very soon.
The letter (reference number MLX278) is available on the Medicines Control Agency website: http://www.mca.gov.uk/.
Many private clinics have already chosen to allow their nurses to administer prescription-only medicines under a PGD, and this would seem to be best practice until new legislation is brought in.
Jane Chiodini, travel health and immunisation nurse specialist, Bedfordshire